Dr. Ali Mattu, Ph.D., Weighs in on Lizzie

by Brian HuntingtonMarch 25th, 2014

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We’ve had Dr. Andrea Letamendi discuss Rick’s mental state back when he was taking calls from his dead wife, and this situation with Lizzie is another great opportunity to have someone really, really smart weigh in on the show and comic. So without further ado, here’s Dr. Mattu:

The Walking Dead’s Scott M. Gimple has done a fantastic job with the fourth season. The show continues to raise the stakes and weave in and out of the comic’s continuity in interesting ways. I was especially interested in what was happening to the kids living in the prison and started writing an articled called How to raise a child in the zombie apocalypse. After this week’s episode, I completely abandoned that article and dove into the psychology behind what’s become the most controversial event in the show’s history. Spoilers ahead for The Walking Dead Season 4 Episode 14 – “The Grove”.

What happened?

After the Governor destroyed the prison safe-haven, Lizzie was traveling with her younger sister Mika, baby Judith, and adults Carol and Tyreese. We’ve known for a while that Lizzie sees walkers (zombies) differently than other people. She gave walkers names as if they were people, secretly fed them mice, and claimed that she understood their thoughts. We also know she killed rabbits, but we don’t know for what purpose. When Lizzie and Mika were trying to avoid detection from nearby walkers, she nearly smothered baby Judith. You don’t have to be a child psychologist to find these behaviors strange and concerning.

Things really escalate in this week’s episode. Lizzie pleads with Tyreese to keep a trapped walker alive. Later, she freezes when a walker attacks her and after her younger sister kills it, Lizzie has to “look at the flowers” to calm down from her panicked state. When Carol kills a walker that Lizzie was playing tag with, Lizzie yells, “How would you like it if I killed you?!?” In the climax, it’s revealed that Lizzie has killed Mika by stabbing her in the chest. “Don’t worry. She’ll come back. I didn’t hurt her brain.” Lizzie makes it very clear she was also about to kill baby Judith as well. After a long discussion, Carol and Tyreese decide it’s not safe for them to be around Lizzie. Carol leads Lizzie out into a field and kills her.

“Lizzie Was Crazy, Right?!?”

“[The Walking Dead] could have probably explained Lizzie’s craziness more clearly, that by turning Mika into a zombie, Lizzie thought she was freeing Mika for the horrors of everyday life — like getting it over with — or by explaining that Lizzie saw so much death that she decided zombies are still people as a coping mechanism. As it is, Lizzie is obviously crazy, but we don’t really have any reason why.”

I agree that the show doesn’t give us any insights into what Lizzie was thinking. But what bugs me is the use of the word “crazy”. Crazy isn’t a term used in mental health. It’s imprecise and stigmatizing. When most people think of “crazy”, they usually mean problems with hallucinations (seeing or hearing things that aren’t there), delusions (believing something that doesn’t have any evidence to back it up), or psychopathy (not experiencing empathy for other people).

In Lizzie’s case, because she killed rabbits, aided walkers, almost killed a baby (twice), and killed her sister, a lot of people think Lizzie was psychopathic. If you look closer at what we know about Lizzie and the science of psychopathy, it becomes clear that Lizzie was struggling with the zombie apocalypse but she wasn’t a psychopath.

Psychopathy in Kids

Psychopathy is always found in adult antisocial personality disorder (not people who hate social situations, but people who break society rules — you know, like not murdering people). But personality disorders aren’t diagnosed in kids – their brains are developing and their personalities still changing. Instead, psychologists look for kids with callous-unemotional traits. Most kids are quick to act and are easily upset when things don’t go their way. Callous-unemotional kids aren’t impulsive — they act in very calculated ways to get what they want. Here’s an example of a callous-unemotional kid from a fantastic review of psychopathy in children from the New York Times:

“A 9-year-old boy named Jeffrey Bailey pushed a toddler into the deep end of a motel swimming pool in Florida. As the boy struggled and sank to the bottom, Bailey pulled up a chair to watch. Questioned by the police afterward, Bailey explained that he was curious to see someone drown. When he was taken into custody, he seemed untroubled by the prospect of jail but was pleased to be the center of attention.”
Not all kids with callous-unemotional traits grow up to become serial killers (some of them become neuroscientists), but they’re the ones who’re most at risk for developing psychopathy.

What causes psychopathy? Scientists have linked violent behaviors like torturing animals, manipulating others to benefit your own interests, and murder to low levels of cortisol (a hormone released when you are stressed) and low activity in the amygdala (the area of the brain responsible for experiencing fear and shame). People who have psychopathy really are coldblooded — they don’t experience as much fear and stress as everyone else. When most kids do break social rules, they feel bad about what they did. Overtime, this leads to empathy and prevents violent behavior. Psychopathic kids don’t make these connections. The parts of the brain that prevent violent and cruel behavior just don’t develop for them.

Lizzie just doesn’t fit the mold of a callous-unemotional psychopathic kid. She’s actually very emotional — we see at least two examples of times when she felt panicky and needed to look at flowers to calm herself down. She also felt regret when she thinks she has disappointed Carol. A psychopathic kid wouldn’t experience these feelings. More importantly, Lizzie does feel a lot of empathy…for the walkers.

Understanding Lizzie’s Strange Behavior

So what was wrong with Lizzie? To answer that question, we have to do what psychologists call a behavioral functional analysis — basically try to understand how her actions were satisfying her needs.

Let’s look at Lizzie’s behavior. If she’s alone with a walker, she doesn’t experience fear. The only time she does get afraid near a walker is if another person is nearby. In that situation, she tries to avoid detection by the walkers or pleads with the person to not kill the walker. If she successfully keeps the walkers from dying, she feels fine. But if walkers end up dying, she gets distressed. She feeds the walkers mice and leaves a bunch of dead rabbits around the forest. All of these behaviors point toward one basic idea — Lizzie feels cares for the walkers and does everything she can to protect their lives.

We already know Lizzie believes walkers are misunderstood. But she probably also thinks humans and walkers are similar things. That’s why she protects them — she has empathy for walkers. She might also think no one really dies until they’re killed in their walker state. That’s why she yells “how would you like it if I killed you” at Carol when she stabs a walker. That’s why she fed mice to the walkers — she felt bad for them. That’s why she almost smothered Judith — by silencing Judith, she was trying to prevent the walkers from approaching and getting killed by her sister. At the same time, she believed that Judith wouldn’t really die from being smothered — she’d return as a walker (which is just as good as a human). This all makes sense — if walkers are the same as humans, of course.

A kid growing up in the zombie apocalypse could get confused about life, death, and zombie resurrection. Children’s brains change a lot in the first 13 years of life and so does the way they see death. Up until the age of 6, kids might think death is temporary and reversible, or that if they think positive thoughts they can bring a loved one back to life. Sounds a lot like what was happening with Lizzie, right? Sure she’s a lot older than 6, but she’s been living in this dystopia for many years. Chronic traumatic stress is really bad for the developing brain. Especially for kids born with strong emotions (“look at the flowers”) the stress of constantly moving, bad nutrition, and no stable parents in your life could lead to the type of delays in development we see with Lizzie.

Could Lizzie Have Been Helped?

Reducing Lizzie’s chronic stress could have helped her feel calmer. She could have also learned emotional regulation skills to feel more in control of her feelings. Then, once she became more stabilized, her sister Mika or a trusted adult could have helped her to better understand the relationship between humans death and walker death.

Unfortunately, this just isn’t possible on The Walking Dead. Season four has shown that there is no room for rest in this world — threats from walkers and humans are never-ending (speaking of which, The Governor TOTALLY has psychopathy).

I watch this show because I love the characters and we see ultimate resilience in face of total extinction. As hard as it was for me to watch “The Grove”, I’m glad Scott M. Gimple told the story he did. It’s a reminder that chronic trauma changes the brain and these changes have a tremendous impact on the most vulnerable members of our society.

Ali Mattu, Ph.D. is a clinical psychologist at the Columbia University Clinic for Anxiety and Related Disorders with expertise in social anxiety, obsessive-compulsive disorder, and hair-pulling disorder (trichotillomania). He worked to fight the stigma of mental illness and increase access to effective treatments during his time on the American Psychological Association’s Board of Directors, across multiple Society for the Teaching of Psychology Presidential Task Forces, and most recently on the New York State Psychological Association’s Executive Committee. Dr. Mattu credits Star Trek for giving his life purpose and he writes about the psychology of science fiction at Brain Knows Better in the hopes that it will help others develop a love for the brain and behavioral sciences. Connect with Dr. Mattu through Twitter and check out his podcast, The Super Fantastic Nerd Hour.

This article previously appeared on Brain Knows Better and Dr. Mattu was nice enough to let us post it here in it’s entirety for you guys!

Interesting. I had just assumed that Lizzie was supposed to be an early schizophrenic when she said that she ‘heard’ them and that she had an episode and became violent. Naturally schizophrenia could possibly be controlled with medication in the pre-walking dead world, but how could anyone medicate her properly even if they had access to medication in their current world. I just know the whole Lizzie storyline was powerful and I loved it.

I’m glad it was explained. I ‘felt’ she could be helped, but couldn’t figure out how it could be done. It’s sad she had to be sent ‘away’. It’s REALLY horrible about Mika. I was so afraid for Judith, I couldn’t spare too much time hoping for Lizzie. So sad for both her and her family. Somewhere inside, I felt her parents knew about her situation, but did nothing when there was time to do it.